MedicaidPrior AuthLow impact
MAB2024070204
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Pharmacy·Provider Bulletin
Effective date
Jul 15, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all Zynteglo (betibeglogene autotemcel) prescriptions effective July 15, 2024. This gene therapy drug for transfusion-dependent β-thalassemia must be prescribed by specialists at qualified treatment centers and meet strict clinical criteria including genetic testing confirmation and transfusion history requirements.
Action Required
By July 15, 2024: Providers prescribing Zynteglo must obtain prior authorization through PROMISe system before dispensing. Ensure prescription is from qualified treatment center specialist and patient meets all clinical criteria including genetic testing for β-thalassemia diagnosis and documented transfusion history (100 mL/kg/year or 8 episodes/year for prior 2 years). Pharmacies must verify prior authorization before dispensing.